Applicants should download or print the Application Kit—it contains all the necessary documents.
Please read the instructions carefully before completing your application.
Application Kit for Reactivation from Retirement
The application kit is a PDF file (Adobe Portable Document Format). You must have the Adobe Acrobat Reader Plugin for your browser in order to download or print the documents. Acrobat Reader is a free download from Adobe. It can be obtained by clicking on this link. First download the reader, then run the installation program to add the plugin to your browser.
The application documents are also available in Word format. IF YOU CHOOSE NOT TO USE THE KIT, THEN YOU MUST DOWNLOAD OR PRINT ALL THE DOCUMENTS BELOW. ALL FORMS MUST BE SUBMITTED.
- Reactivation from Retirement Letter
- Application Checklist
- Authorization for Release
- Medicare Tax Form
- Malpractice History Form
This information is provided by the Board of Registration in Medicine.